title: Premature failure of a Riata defibrillator lead without impedance change or inappropriate sensing: a case report and review of the literature.
abstract: A 63-year-old woman with a St. Jude Medical Riata 1570 right ventricular lead complained of intermittent hiccups 2 months after implant. Interrogation revealed elevated pacing threshold and diaphragmatic stimulation. Pacing and shock lead impedances remained stable. No inappropriate sensing was noted. Fluoroscopic examination of the lead revealed a thin radio-opaque wire seen between the 2 defibrillator coils away from the main body of the lead. After extraction, a tear in the insulation of the lead was noted allowing the inner wire to protrude. This case illustrates a novel mechanism of insulation failure without inappropriate sensing or impedance change.
authors.affiliation: Section of Cardiac Electrophysiology, Division of Cardiology, Johns Hopkins Medical Institutes, Baltimore, Maryland, USA.
authors.forename: Angela
authors.initials: A
authors.lastname: Krebsbach
authors.forename: Fawaz
authors.initials: F
authors.lastname: Alhumaid
authors.forename: Charles A
authors.initials: CA
authors.lastname: Henrikson
authors.forename: Hugh
authors.initials: H
authors.lastname: Calkins
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Berger
authors.forename: Alan
authors.initials: A
authors.lastname: Cheng
mesh_terms: D017147:Defibrillators, Implantable / Q000009:adverse effects* / Q000592:standards; D004554:Electric Countershock / Q000009:adverse effects* / Q000295:instrumentation*; D017097:Electric Impedance; D004868:Equipment Failure; D005260:Female; D006801:Humans; D008875:Middle Aged; D013997:Time Factors